a cancer affecting the head and neck known as head and neck squamous cell carcinoma (HNSCC)

Keytruda is mainly used for cancers that are advanced, have spread to other parts of the body (metastatic) or are not responding to other treatments. In some cancers, it is only given to patients whose tumours produce high levels of a protein known as PD-L1.

Keytruda is also used to help prevent the cancer from coming back after they had surgery to remove melanoma (adjuvant therapy).

Keytruda is used on its own except for non-squamous NSCLC where it is used in combination with pemetrexed and platinum chemotherapy.

Keytruda is given as an infusion (drip) into a vein. The recommended dose is 200 mg once every three weeks.

The doctor may need to delay doses if certain side effects occur, or stop treatment altogether if side effects are severe.

Before starting treatment, patients with NSCLC, previously untreated urothelial cancer or cancer of the head and neck should have tests to check their levels of PD-L1.

The medicine can only be obtained with a prescription and treatment must be started and supervised by a doctor experienced in the treatment of cancer. For more information about using Keytruda, see the package leaflet or contact your doctor or pharmacist.

The active substance in Keytruda, pembrolizumab, is a monoclonal antibody, a type of protein that has been designed to recognise and block a receptor called PD-1. Some cancers can make a protein (PD-L1) that combines with PD-1 to switch off the activity of certain cells of the immune system (the body’s natural defences) preventing them from attacking the cancer. By blocking PD-1, pembrolizumab stops the cancer switching off these immune cells, thereby increasing the ability of the immune system to kill the cancer cells.

Skin cancer

Keytruda is effective in delaying worsening of melanoma and improving survival. Results from a study of 540 previously treated patients with melanoma showed that 2 years after start of treatment, the disease had not worsened in 16% of patients treated with Keytruda compared with less than 1% of patients treated with chemotherapy.

A second study looked at 834 patients with melanoma who received either Keytruda or another medicine, ipilimumab. Results from this study showed that the patients treated with Keytruda lived for up to 5.6 months without their disease getting worse compared with 2.8 months with ipilimumab. The study also found that patients treated with Keytruda lived longer than patients who received ipilimumab. Up to 74% of patients lived for at least 12 months after start of their treatment compared with 59% of patients on ipilimumab.

A third study in 1,019 patients who had had surgery and who were at high risk for their cancer coming back compared Keytruda to placebo (a dummy treatment). After one and a half years of treatment, 72% of patients on Keytruda were still disease-free compared with 54% of patients on placebo (a dummy treatment).

Non-small cell lung cancer (NSCLC)

Keytruda is also effective in delaying worsening of the disease and improving survival in patients with NSCLC that tested positive for the PD-L1 protein.

In a study looking at around 1,000 previously treated patients, patients lived longer with Keytruda given alone (around 11 months) than with another cancer medicine called docetaxel (around 8 months) and the period during which the disease did not get worse was around 4 months with both treatments. Keytruda was more effective in patients who tested strongly for PD-L1, with these patients living for 15 months on average, 5 months of which without their disease worsening.

In a second lung cancer study of 305 patients whose tumours tested strongly for PD-L1 who had not been treated before, patients on Keytruda lived for around 10 months without their disease getting worse compared with 6 months in patients taking platinum-based chemotherapy.

Keytruda is also effective in combination treatment of non-squamous NSCLC. In a study of 616 patients with non-squamous NSCLC that had spread, 69% of patients taking Keytruda with pemetrexed and platinum chemotherapy were alive at 11 months, compared with less than half of patients who had only pemetrexed and platinum chemotherapy.

In addition, patients who had Keytruda treatment lived on average for 8.8 months without the disease getting worse compared with 4.9 months for patients who were not given Keytruda.

Hodgkin lymphoma

Keytruda partially or completely clears cancer cells in classical Hodgkin lymphoma that had not responded to or returned after treatment with brentuximab vedotin, with or without an autologous stem cell transplant.

In a main study of 210 patients, Keytruda produced a complete or partial remission (clearing) of the cancer in 145 patients (69%); a complete remission occurred in 47 (22%) of them, meaning they no longer had any signs of cancer. The average time that the response lasted and patients lived without their disease getting worse again was around 11 months.

Urothelial cancer

Keytruda improves survival of patients with urothelial cancer. A study looked at 542 patients previously treated with platinum-based medicines who received either Keytruda or another cancer medicine chosen by the doctor (paclitaxel, docetaxel or vinflunine). Patients lived on average longer with Keytruda (around 10 months) than with the other cancer medicines (around 7 months), although Keytruda did not delay worsening of the disease compared with the other cancer medicines (time to disease worsening was 2 and 3 months respectively).

In a second study of 370 patients who could not be treated with cisplatin-containing medicines, Keytruda produced a complete or partial remission (clearing) of the cancer in 108 patients (29%); a complete remission occurred in 30 (8%) of them, meaning they no longer had any signs of cancer.

Head and neck cancer

Keytruda is also effective in improving survival of patients with head and neck squamous cell carcinoma (HNSCC) that had spread or come back. In a study of 495 patients, patients treated with Keytruda who had high levels of PD-L1 lived on average for 11.6 months compared while those taking standard cancer treatments lived for 6.6 months.

The side effects of Keytruda are mostly related to the activity of the immune system, which may cause inflammation of body organs and tissues and can be serious, although most side effects resolve with appropriate treatment or on stopping Keytruda. The most common side effects of Keytruda given alone (which may affect more than 1 in 10 people) are tiredness, rash, itching, nausea (feeling sick) and diarrhoea. When combined with other cancer medicines the most common side effects (seen in around 1 person or more in 5) are nausea (feeling sick) and vomiting, low levels of red or white blood cells (anaemia and neutropenia), tiredness, decreased appetite and diarrhoea.

For the full list of side effects and restrictions with Keytruda, see the package leaflet.

Keytruda is effective at improving survival or delaying the worsening of disease in patients with advanced cancers or cancers that have spread or come back. In some patients, tumours have to produce a high level of PD-L1 for the medicine to be effective.

Keytruda is also effective in preventing melanoma from coming back in patients that had surgery.

The side effects seen with this medicine are manageable and are similar to those seen in various other cancer treatments.

The European Medicines Agency decided that Keytruda’s benefits are greater than its risks and it can be authorised for use in the EU.

The company that markets Keytruda will provide educational packs for doctors who are expected to prescribe Keytruda containing information on how the medicine should be used and how to manage side effects, particularly side effects on the immune system. Information on the risks of being given donor stem cell transplants after Keytruda treatment will also be included. The company will provide an alert card for patients with information on the risks of the medicine, as well as instructions on when to contact their doctor if they experience symptoms.

In addition, the company will provide the final results of studies with Keytruda to confirm the long-term benefits of the medicine. Moreover, the company will carry out analyses to better understand which patients are likely to benefit most from treatment with Keytruda.

KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumours have no EGFR or ALK positive mutations.

KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic NSCLC in adults whose tumours express PD-L1 with a ≥ 1% TPS and who have received at least one prior chemotherapy regimen. Patients with EGFR or ALK positive tumour mutations should also have received targeted therapy before receiving KEYTRUDA.

KEYTRUDA as monotherapy is indicated for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV), or who are transplant-ineligible and have failed BV.

KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy.

KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy and whose tumours express PD L1 with a combined positive score (CPS) ≥ 10.

KEYTRUDA as monotherapy is indicated for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a ≥ 50% TPS and progressing on or after platinum-containing chemotherapy.